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hopefully there's someone on here with some experience of dealing with illiotibial band syndrome.

I've been suffering with ITB problems for over a year now, only recently got it together to start trying to sort things out. I've been to a few physios and have plenty of stretches and exercises to be getting on with but I'm still unsure about what might have caused the ITB tightness in the first place and what (if anything) I can do to my position to help prevent the ITB tightening.

I have heard lots of contradictory stuff from physios and bike fitters - saddle up/saddle down, cleats one way then the other....

Anyone have any tips? Specifically I'm wondering about saddle setback and cleat rotation. Even if this means my position is no longer ideal for power or comfort - number one priority at the moment is to stop the lateral knee pain in my right knee. So far the stretches alone don't seem to have wholly solved the problem.

Also - should I bother icing my knee after low mileage training, even though I'm not pushing to the point where I experience pain? (I have to do about 30km or so before my knee starts to hurt)

**** Without seeing you I have no clue what predisposing factors or bike fit issues may be causing your ITB band problems. Many times, people have glute activation and other kinetic chain or muscular/flexibility anomalies that can cause or exacerbate ITB issues. Bow legged people, knee knocked people, weak ankles, lower leg issues, and even some congenital conditions related to synovial plica can contribute to your problems. There are a LOT of other things that can cause ITB, and it sounds like your problem may be multi-faceted if your health professionals have not been able to give you consistent advice. There is a reason its called "practicing" medicine.

I assume you are doing foam rolling and have tried other types of self myofascial release along with your stretching - if not, you should be doing this.

There is rarely an easy answer to a problem like ITB friction, but it is exceedingly rare to need surgical intervention and aggressive physio therapy and other modalities done in a consistent manner WILL help you over the long haul assuming you are doing the right things.

Icing, etc.. might allow you to recover from a bout after a ride, but in my opinion it is otherwise worthless as it does not address the underlying reason you have the problem in the first place.

Your problem can be fixed, it is just a question of doing the right things on a regular basis. Your problem does not lend itself well to being solvable on an internet forum, but perhaps others will share what has worked for them and you take that advice into consideration.

Rudder, I had a nightmare last year with ITB, it kept reocurring regularly but this year has been fine for me, no problems at all.These are some of the things I found worked for me, not saying they're guaranteed to work for you but give some of them a go.I suffered from a bad back in the early spring and started to ride with a lower than usual saddle height, this I beleive was the start of all my problems.Stretches, stretches and more stretches, hamstrings and the ITB stretch from google, it's a bit odd to get right but seems to help.Loads of rest when it flares up, don't ride on it once it's occured, you need to rest it to stop the irritation getting worse.Don't massage it, it makes it worse.Plenty of ice and Ibuprofen gel applied locally to get rid of the inflamation works very well.I changed pedals from Time to Shimano SL, and that seemed to make a big difference, I found the pedal offered more support on my shoes and allowed my feet to fall into a natural alignment easier than the Times.I turned both my cleats so as to get my heels as tight to the chainstay as possible ie: turned the ball of my foot out and this seemed to help alot as well.Try pulling your saddle up a couple of mm at a time and see if that improves it for you.The only way to beat it is to rest though, all the time you ride without letting it recover properly it just gets worse and worse.

@coachpotatobilly - I didn't realise the causes could be so complicated, guess I'll have to go back to the physio to check for any wider flexibility/muscle balance issues. I'll continue doing my stretches but had hoped that it might be easier to pinpoint the cause.

@legs11 - good to here you're sorted now. I've just changed to shimano SPD-SL as well (from speedplay) and it does feel much more stable, especially now I've finally found some wider shoes that actually fit me! Interesting what you're saying about moving the heels in, I'll definitely give that a go.

I think raising the saddle may be a good idea as well. One bike fitter I went to told me to lower it right down (~2cm from my original position) to achieve a horizontal foot at the bottom of the stroke, however another bike fitter reckoned raising it might help with the ITB by extending my leg towards the top of the stroke. I'm also considering going from 175 to 170mm cranks to reduce knee flexion slightly.

I had ITBFS about 3 years ago. I eventually ended up getting ITB release surgery, which was very effective. I was back to riding a few months after the surgery, but it took a few years for the pain to completely resolve, although I was able to continue to ride as long as I stretched before (and sometimes during) a ride. Since then my IT Band has gotten considerably tighter, so even with surgery it is necessary to stay on top of this condition. Following are the things that I did to treat this condition, aside from surgery, (in approximate order of importance).

Use foam roller - every day. I think this is the single most important thing as it seems to be much more effective than traditional ITB stretching for loosening the IT band.

ITB stretches, hip stretches, quad stretches.

Widen tread/Q factor - via cleat positioning and washers/spacers to move the pedals out. Using a triple crankset (Shimano) gives a slightly wider tread than a double (all other things being equal).

Make sure that cleat is positioned to lessen ITB tension. Rotate heel towards the crankarm (inward) while also avoiding medial knee pain.

Consider using "wedges" (between cleat and shoe) or orthotics/sole inserts to raise outer side of foot, lessening tension on IT Band.

Move seat back and up. Seems to increase involvement of hamstrings, lessen role of quads, with less tightening of IT Band during riding.

Whatever you do, don't try more than one thing at the same time! Get some orthopaedic insoles, consult a capable expert in your area for it. Then (maybe!) adjust your position.

ITB mostly happens when changing training intensity or volume (spring and fall). Be prepared and do basic stretching for the whole leg from toe to hip, inside, front, back and outside (I googled five or six exercises which my orthopaedist confirmed later on). Ten minutes in the morning and in the evening is enough.

Insoles and stretching during a few weeks spring and fall cured me immediately and I never experienced any troubles again. In fact I don't remember which year I got ITB for the last time.

Rest works every time for me. I would cut way back on riding for awhile. Not what you want to hear I think.

Massage helps me also. So does elec stim as done by a PT

In the future apply rest/recovery before the issue gets out of hand

Are you riding over geared? Pushing harder then your actual fitness dictates?

I would suggest caution when changing bike positions. Get a full bike fitting by the best person you can find. Hopefully someone trained in several fit systems and years of practice. Not from your average LBS employee of the month

@davidwaller - thanks for the advice, I've never even considered surgery but perhaps it is something to look into. Did someone advise you re. the Q factor and wedges adjustments? I only ask because my bike fitter suggested a narrower Q factor and raising the inner side of my foot to compensate for a slight flat-footedness.

Whatever you do, don't try more than one thing at the same time! Get some orthopaedic insoles, consult a capable expert in your area for it. Then (maybe!) adjust your position.

I would suggest caution when changing bike positions. Get a full bike fitting by the best person you can find. Hopefully someone trained in several fit systems and years of practice. Not from your average LBS employee of the month

Definitely good advice - I'm hesitant about changing anything because my current position is the result of 2 bike fits from reputable fitters. Problem is that none of the fitters or physios I've spoken too seemed very certain about how my position could be contributing to the ITB problems, or what I could do other than stretching to improve things. Maybe the position that is best for comfort and power might not be best for my knee?

I've been off the bike for 6 months now, stretching daily for the last 3 months. Tried going for a couple of quick rides last week and things are better, but not by much. Since then I've changed pedals, shoes and bought custom insoles, and after coachpotatobilly's post I'm going to go and check for any flexibility issues etc. that might be contributing.

rudder wrote:@davidwaller - thanks for the advice, I've never even considered surgery but perhaps it is something to look into. Did someone advise you re. the Q factor and wedges adjustments? I only ask because my bike fitter suggested a narrower Q factor and raising the inner side of my foot to compensate for a slight flat-footedness.

I've been off the bike for 6 months now, stretching daily for the last 3 months. Tried going for a couple of quick rides last week and things are better, but not by much. Since then I've changed pedals, shoes and bought custom insoles, and after coachpotatobilly's post I'm going to go and check for any flexibility issues etc. that might be contributing.

I got most of my information from various published sources (mostly books, research studies, etc); I was never advised per se. I believe that a narrower Q factor will tend to aggravate ITBFS. I went through a lot of things (including physical therapy, iontophoresis, etc) before the surgery, and did not resort to surgery until I had been afflicted for a year or more. Obviously the number one concern right now is alleviating the ITBFS; any other fit considerations should be somewhat secondary to the IT Band issue. The "ideal" position from some fitters point of view may not be ideal for you right now as you need to reduce the stress on the IT Band as much as possible in order to be able to continue riding. My impression is that once ITBFS has become chronic (about 6 or months) it can be difficult to treat successfully without surgery. That seemed to be true in my case.

Not that surgery is always the answer... but there is a new technique called a "Topaz" procedure. The surgeon will make an incision along the IT band on the side of the knee. He uses a "wand" type instrument which will effectively burn microscopic holes in the tendon. This will in turn promote blood flow and healing.

After dealing with ITBS for years, I went from not being able to ride more than 45 minutes, to having no pain at all within 1 week after the procedure. There is virtually no recovery time.

Thought I'd just update this for anyone searching for ITB advice in the future. I've just managed my first 50 mile ride for 14 months - the ITB still feels tight but I am at least pain-free.

Despite religiously stretching and using a foam roller every day for several months, the ITBS wasn't improving significantly.

I made a few changes to my bike position, one at a time to try and feel what, if any, difference it made to the ITB. A slight saddle height increase and ~1cm aft movement of the saddle seemed to help a little, so did switching from free-float speedplays to zero-float shimano spd-sl. Angling the cleats so that my heels were moved towards the chainstay has made the biggest impact, ITB is noticeably worse if I revert to my old angle.

My shoes were too narrow for me but I couldn't feel any change to the ITB tightness after switching to correct-width shoes, although stability has improved. Switching from 175 to 170mm cranks also doesn't seem to have made an impact.

I'm still unconvinced about whether a narrower or wider q-factor would help ITBS, and I haven't yet experimented with cleat wedges. From what I've heard high cadence/low gear should help with ITBS but I was already using a high cadence so don't know if this is true...

I've also been diagnosed with a slight pelvic asymmetry which could be a contributing factor, about to start treating it with pilates. And I'm getting a new frame to reduce the reach to the bars, which will help reduce the lateral movement of my knee during the pedal stroke. So hopefully the ITBS will continue to get better and I can avoid surgery in the future.

To anyone with ITBS - rest/stretch/myofascial release/massage should always come first! Don't resort to fiddling with bike position unless you have to. That said, don't take for granted that the position you have been fitted to is best for avoiding ITB tightness, in my experience even respected fitters don't have much of a clue how to adapt position to help ITBS. Also, like CoachPotatoBilly mentioned - get a good physio to check for any muscular/flexibility anomalies which could be the cause.

I have also been dealing with ITBS issues for awhile now and would like to add some of my observations.

I was using speedplay zeros and the pedals tend to wear out very easily. My feet ended up rocking back and fourth which I think exacerbated the problem with ITBS. Here is a good write up of the speedplay rocking issues:http://www.epdoc.com/mvv/speedplay/index.html

I just switched to shimano spd-sl and hopefully will have better luck.

A great exercise is using a foam roller. Lay on your side with the foam roller under one leg between knee and hip. Using your upper body glide the roller up and down the outer part of your thigh. It takes a bit of getting used to but once you have the technique down you can rotate your leg to hit other parts of the thigh.